Dental anxiety in paediatric patients: Is cognitive behavioural therapy effective?


Fear of dental treatment is common in children and is often found where that have been previous negative dental experiences. Sedation and general anaesthesia are often used to enable dental treatment for these children but are unlikely to help overcoming fear in the long term.   Cognitive behaviour therapy (CBT) has been shown to be beneficial in adults and systematic reviews have shown CBT to be effective in reducing general anxiety in children.

The aim of this review was to determine to what extent CBT produces a reduction in dental anxiety and dental phobia in children


Searches were conducted in the Cochrane Library, Embase, PubMed, Scopus, Web of Science, LILACS/BBO, PsycINFO ,ProQuest dissertations and Theses full text, OpenGrey databases and the trials registries, ISRCTN registry, UK National Institute for Health and Care Excellence, and International Clinical Trials Registry Platform.  Randomised controlled trials (RCTs) in patient under 18 years of age with dental anxiety or dental phobia measured using validated scales where CBT was compared with controls were considered. Two reviewers independently screened, selected abstracted data and assessed risk of bias using the Cochrane tool. A narrative synthesis was provided.


  • 6 RCTs involving a total of 269 patients were included
  • 2 studies were considered to be at high risk of bias and 4 at unclear risk.
  • Patients age range from 41 months to 18 years.
  • The number of CBT sessions ranged from 1 to 10.
  • CBT was compared with conventional behavioural management techniques, N2O/O2, sedation, general anaesthesia, non-intervention, sensory information, modelling, information dissemination, and waiting list.
  • Anxiety, Fear and cooperation were assessed using a broad range of measurement tools.
  • All studies sought the children’s perception of their anxiety.
  • 5 studies showed significant decreased levels of anxiety/fear compared to controls, regardless of the evaluation methods used or evaluation time of CBT after receiving the treatment.
  • 3 studies demonstrated a positive effect on cooperation/behaviour.
  • The level of evidence for these findings is low.


The authors concluded: –

Cognitive behaviour therapy produces better anxiety reduction than diverse behavioural management techniques, but the evidence was of low quality and further studies in children are needed.


The reviewers have undertaken a broad search of relevant databases for randomised controlled trials to address their review question.  The small number of studies meeting the inclusion criteria, and the wide range of evaluation criteria used meant that meta-analysis could not be conducted.  Five of the included studies demonstrated decreased levels of fear and anxiety in those receiving CBT with 50% of the studies showing positive effects on cooperation/behaviour. The format of CBT in the studies varied with 3 studies delivering it in a single session although repeated graded exposure is a core element of CBT.  While this review highlight the potential benefit of CBT in reducing paediatric dental anxiety /fear additional research is needed to clarify the format of the CBT intervention and improve the quality of the available evidence.


Primary Paper

Gomes HS, Viana KA, Batista AC, Costa LR, Hosey MT, Newton T. Cognitive behaviour therapy for anxious paediatric dental patients: a systematic review.Int J Paediatr Dent. 2018 Jul 8. doi: 10.1111/ipd.12405. [Epub ahead of print]PubMed PMID: 29984460.

Original review protocol in PROSPERO

 Other references

 Dental Elf – 20th Sep 2012

Measures of Children’s dental anxiety


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